Lesser Sac Haematoma-Melioidosis - A Surgical Surprise

Melioidosis, a potentially fatal disease endemic in South East Asia and Northern Australia is caused by Burkholderia pseudomallei, a potential bioterror agent. It is a motile, aerobic non-spore forming gram negative bacillus often characterised by pneumonia and multiple abscesses, but it can also present as septic arthritis, cutaneous ulcer and osteomyelitis. Modes of acquisition are inhalation, inoculation and rarely ingestion from a contaminated environment.1 General and gastro surgeons rarely come across abdominal melioidosis and rare is a lesser sac haematoma secondary to mycotic aneurysm of splenic artery caused by melioidosis. Clinical manifestations can vary from asymptomatic infections to localised abscesses to fulminating diseases with multiorgan involvement and eventual death. Due to evolving lifestyle, extensive travel and climate changes the disease which was previously confined to specific countries has crossed its boundaries. Increase in cases of comorbid conditions like diabetes and immunocompromised states have added on to the cause of increasing rates of the disease worldwide. India has seen isolated case reports from few states. Most often Burkholderia pseudomallei is misreported as pseudomonas species especially in resource-poor laboratories making the disease potentially fatal due to error in the treatment protocol.2 Due to its high chance of recurrence, prolonged treatment with combinations of antibiotics is required for complete eradication.